Introduction: The distal forearm is the most common fracture site in children. The stresses from a fall on the outstretched hand are prone to result on a physeal or metaphyseal fracture of the distal radius. Fortunately subsequent growth disturbance is unusual. Our aim is to report the advantages or disadvantages of the Kapandji method compared with the crossed pin fixation.

Materials and Methods: We reviewed 29 children brought to the operating room for reduction and percutaneous fixation of distal forearm fractures during the last 18 months. There were 23 boys and 6 girls aging between 4 and 15 years old. Fractures were classified in four general types: physeal, torus, greenstick and complete. Sixteen fractures were fixed using the Kapandji technique and 13 were fixed with crossed pins.

Results: All patients recovered full range of motion. None of the fractures required open reduction. Pinning using the Kapandji technique was easier and took about 50% less of the operating time. Nevertheless we found that there was no leading criteria to decide which were the fractures that would need pinning after reduction. There was an incidence of 10% of superficial infections that subsided after removal of the wires with no further complications in both methods.

Conclusions and Discussion: Radial collapse, loss of wrist motion, and distal radioulnar joint dysfunction, all common problems associated with distal radius fractures in the adult, are rarely seen after children’s distal radial fractures. Closed reduction is usually easy. Although the final results were the same comparing crossed pin fixation and the Kapandji method, the later proved to be easier and less time consuming in the operating room. For this reason we favour this type of fixation for the distal forearm fractures in children.

Perthes disease in children above 8 years old, generally has a worst prognosis. On this age group it is common that hinge abduction appears in a descentered and uncontained hip, situation that has a difficult solution with the standard surgical procedures. On those cases arthrodiastasis as described, can be a valuable treatment option.

The rationale of arthrodiastasis on Perthes is that it permits to reduce the hip, protect it during the fragmentation stage, and creating a vacuum phenomenon inside the acetabulum it “insufflate” the collapsed plastic head, permitting the reconstruction of a spherical head.

Our actual protocol to treat Perthes disease in a more than 5 years old child, include a transphyseal tunneling made as soon as possible on the necrotic stage and protection of the hip in a abduction-flexion brace. If at any time a hinge hip develops then arthrodiastasis is applied.

The procedure is simple, fast and low traumatic, including the positioning in a traction table, application of a Ilizarov frame with hinges centered on the center of rotation of the head, with the limb in a position of abduction and slight flexion, which permits the reduction and containment of the hip, and then a progressive arthrodiastasis to 1 1.5 cm. The frame was used for 3–5 months and during this period one could assist to the progressive growth of the collapsed femoral head. After arthrodiastasis the hip is protected with an abductionflexion brace for a mean of 8 months.

The Authors present the 5 first cases where this methodology was applied, standing out the good results obtained, without complications, mentioning the faster evolution to reconstruction stage in the cases where transphyseal tunneling was done, permitting a shorter period of arthrodiastasis.

The pelvic ring unstable disruptions are by itself life threatening and its stabilization is one of the priorities. On the other hand the surgical approach and internal fixation of this type of injuries represent a long and aggressive intervention, with high blood loss and complications. By these reasons a methodology that not only allows a precocious and less aggressive intervention with the possibility of stabilization of the posterior and anterior elements of the pelvic ring, and also the possibility to introduce postoperative corrections is indicated.

In January 1999 we introduce in our Unit the treatment of pelvic ring fractures and disruptions with the association of Ilizarov frame and minimal invasive internal fixation. It is our intention to present the preliminary protocol of treatment and its results.

Until 2002 we have treated 97 cases of pelvic ring disruptions. We have treated surgically 26 patients. From those, 10 cases were of open book and closed book injury type (2 pubic platting, 4 static external fixator and 4 dynamic Ilizarov frame) and 7 cases were of vertical shear injury type (4 pubic plating and sacro-iliac bar/ screw, 3 dynamic Ilizarov frame).

Results were evaluated with our own protocol. Infection rate compromised final results of the cases treated by ORIF (4:6) and reduction was poorer with the static external fixator (2:4). Treatment with Ilizarov frame revealed 5 good results and 2 fair results.

The authors conclude that even with a limited number of patients and follow-up, the use of the dynamic Ilizarov frame with a minimal invasive approach, showed to be a simple, fast and efficient method for the handling of serious fractures and disruptions of the pelvic ring, allowing a good stabilization of the anterior and posterior components, permitting the “fine tuning” in the postoperative period, without major complications.